There will be no equal civil partnerships, but for those seeking a Gender Recognition Certificate it’s possible to convert to marriage first. (Section 9) This is an extra set of hoops to jump through which isn’t ideal, and seems to be at odds with the initial claims that conversion and issuing a GRC could be done as a single process. That it’s possible at all is positive however.

Supposedly you can put in a simultaneous Gender Recognition application in the (unlikely) even that both halves of a civil partnership transition and keep the civil partnership. However, the intention was also that annulment and remarriage for a GRC under the old rules would also happen on the same day, whereas in practice that’s not the case.

The bill makes it clear that any converted marriage is to be treated as continuous from the original date of marriage.

If you’re married and your partner consents, you can get a Gender Recognition Certificate and stay married. (Schedule 5) Foreign marriage and marriages in Northern Ireland would still cause a problem here by the looks of things, but realistically there isn’t much the UK Government can do about those.

I don’t see anything on consummation in the bill, which might be of concern to anyone who is non-op. (I.e. retaining their birth genitals) I need to read the bill cover-to-cover to check that one though.

Finally, what’s missing is any provision to restore marriages lost under the old forced-divorce Gender Recognition provisions. That will upset many people,

(Caveat: I only saw the bill for the first time 25 minutes ago so I may have missed something. I’m sure we’ll hear soon enough from those with more time to analyse it)

It’s that time again, when Google release their Transparency Report and I take a look at the per-capita rather than raw data.

The Google Transparency Report lists the number of requests via the courts or law enforcement, by country, for user data. These are often from governments but might also be in response to court orders – the only contry where this is broken down is the United States where The latest figures this time are for the second half of 2012 (2012 H2) so Google are now rather more up to date than they used to be, when they released data 6 months behind. There is remarkably little to report this time, with most countries maintaining their positions in the chart. Australia and France have swapped places, but remain remarkably close to each other, whilst the UK remains in fourth place.

What we do have now that we’ve not had previously is enough data to make it worthwhile charting the progress of Google user data requests over time. The upward trend in the number of requests per country is obvious, as is the fact that despite dropping to fourth place, there is still a steady rise in the number of requests in the UK – we have only dropped down due to other countries increasing their requests at an even more rapid rate.

In the wake of the #TransDocFail hashtag, it has become clear that bad or abusive healthcare at the hands of medical professionals is still as common as it has been historically. Many trans folk have a simple fix for this: don’t tell random medical professionals your full history. This is tougher for trans men but in the case of trans women, “I take HRT and have no uterus or ovaries” tells them everything they need to know. The why simply does not matter one bit in the vast majority of interactions.

But the NHS wants your data, ostensibly because it increases patient safety, and Jeremy Hunt has agreed. Yet again, this is an example of how something that might give a benefit for the majority being wholly unsuitable in both principle and practice for already-marginalised groups. And it is not just medical professionals who will have access to the data: those involved in social care will also gain access.

I doubt that the trans community is the only group affected. One person has already expressed concern that those with mental health issues may also face discrimination. In just the same way as a well-meaning but clueless doctor can assume any complaint must be related to transition, obviously physical conditions often get mistaken for symptoms of mental health conditions in patients who have such a diagnosis.

Not being completely stupid (Hey, stop sniggering at the back) Hunt has promised a opt-out for those that don’t want to be on the new system, just as you can opt-out of the current NHS “Spine” summary database: “You absolutely have to have a process in place for people who don’t want that [data sharing] to happen“.

But opting-out of the spine is tricky, and if you’re obviously opted out of a database that everyone else is on it raises questions.

Trans people have put up with biased reporting and name-calling for years, even suffering from the ignominy of having transphobic writers nominated for awards by LGB campaigning groups. The difference here is that, oblivious to the turning of the tide when it comes to hate speech, Julie Burchill and the editors of The Observer finally crossed a line that mainstream opinion could not ignore.

Anxiety, because I worry what will happen to stories like this when the mainstream press gets hold of them. Besides the usual errors, such as erasure of trans men and use of “transsexuals” as a noun rather than an adjective, coverage has been on the whole pretty positive. Except for one point: The anti-Trans lobby has been allowed to rewrite history in portraying a “baying mob” that hounded Suzanne Moore off Twitter, which was the catalyst for Julie Burchill’s piece. In reality, although someone picked her up for her “Brazilian Transsexuals” comment online, that sort of behaviour is so common that, against the background of lady-boy jokes on BBC TV, that it would not even warrant a footnote in the annals of Trans history. It was her subsequent abusive response to polite criticism from non-Trans people on Twitter including the phrase “lopping bits off your body” that angered people.

If there was a mob on Twitter, then the leader was Suzanne Moore who reacted to valid criticism with abuse before flouncing off the site for a couple of days. But despite some disgusting language from Julie Burchill, her version of the “facts” has been accepted almost unquestioningly by many, because it appeared in a national newspaper.

Of course, my challenge to this on Twitter (After the piece was publicised on Twitter) was characterised as “intimidating” the proving the point, despite the acknowledgement that I was being polite. I do wonder about the mental processes of anyone involved in politics who thinks a polite exchange is intimidating. Have they ever been in a council meeting?

The crux of this argument seems to be that if anyone dares mention Trans issues at all, they will be mercilessly attacked. The trouble is not that a non-Trans person mentioning Trans issues will cause outrage, as I do not see any such response to excellent posts by Caron Lindsay and Jennie Rigg. The issue comes when you assume a position of privilege but act from a position of ignorance.

Oppressed groups have recently found a voice via the Internet, and sites such as Twitter have recently boosted this even further. Journalists such as Julie Burchill (And others before her, such as Suzanne Moore, David Batty and Julie Bindel) have had a voice via the pages of The Guardian and The Observer that enables them to reach a million people. A voice that, according to the Leveson report, “fails to treat members of the transgender and intersex communities with sufficient dignity and respect” and “continues to refer to the transgender community in derogatory terms, holding transgender people up for ridicule“.

Complaining that these people are being silenced when they have such a loud voice that has gone hitherto unchallenged is simple oppression of those who have never had that voice.

If there is an issue with the kind of pieces these people have been writing for years expressed on Twitter, then consider that the internet is revealing decades-old inequalities and injustices, not creating them.

Following on from the news that one of the few private doctors dealing with Trans issues has had complaints made against him by fellow doctors, Sarah Brown suggested that Trans people tweet their bad experiences of doctors using the #TransDocFail hashtag. Most of these failures go uninvestigated, because people are afraid of not being believed or having vital treatment witheld as the following demonstrate:

@AutistLiam: Told counsellor (who also does NHS counselling) abt abusive, gaslight-y behaviour from psych. Was told “She’d never do that!” #TransDocFail@AutistLiam: For example, I never complained about my abusive psychbecause I didn’t want to end the only NHS route out of Place-I-lived #TransDocFail@InWhichAlex: Urologist then stops anyone else trying to treat me, after formal complaint asking for him to no longer be involved in my care #TransDocFail
Anonymous: Charing Cross GIC told my psych that I was suicidal asrevenge, after they discovered a negative blog post I wrote about them.#TransDocFail@TransDocFailAno: “#transdocfail I tried to complain, at which point I was told the next appointment I had for arranging second opinion would be cancelled.”@TransDocFailAno: “#transdocfail I am terrified of talking about my experiences because I am afraid of having treatment withdrawn by the GIC.”

The hashtag took off in a big way. There are thousands of tweets now, but below are a hundred or so grouped by the most common themes emerging from the trend. Even the General Medical Council themselves joined in, pointing people at resources for complaining:

@gmcuk: We have a website to help patients if they’re concerned about the care they’ve received from a doctor http://ow.ly/gDmvQ #TransDocFail

If you’d like to contribute yourself but don’t want to out yourself, an anonymous service @TransDocFailAno, is available via Tumblr.

The NHS doesn’t do that!

Think you can go to the GPs and get treatment for Gender Dysphoria? According to some GPs, the NHS doesn’t deal with Trans people…

@Tara_Hewett: Doctor at GP drop in refused to believe i was seeing endocronolygist on nhs “all that trans stuff is only available privately” #TransDocFail@auntysarah: When I approached GP surgery in 2005, the doctor had never heard of gender dysphoria and “The NHS definitely doesn’t do that” #TransDocFail

The excuse for this is often because doctors have watched too many TV programmes about Trans regret, and think everyone is like that.

@MissCassHoskins: #transdocfail Brighton PCT wont fund laser treatment as they don’t see the benefit@S0phieH: also the NHS denied facial hair removal, so sometimes I’m terrified to walk outside, till I can afford it myself #TransDocFail@auntysarah: Most PCTs will not find hair removal from vaginoplastydonor tissue. Apparently vaginal hairballs are “cosmetic”. #TransDocFail@mixosaurus: In Notts PCT, *all* cross sex hormones were red-listed. GPs didn’t have authority to prescribe; GIC didn’t have funds #TransDocFail@quarridors: Lots of impressively depressing stuff on the #TransDocFail hashtag. I eventually got good treatment but my PCT refused to fund meds in 2002.

The long wait

So you’ve convinced your GP that in fact the NHS does do this sort of thing. And they’ve written a referral for you… or have they? Strangely, referrals for Trans issues often seem to end up lost at the bottom of the pile.

@JessWardman: had a referral to psychotherapy lost for nearly a year. Still no idea why. At time, thought waits that long were normal. #TransDocFail@NotRightRuth: I’m very lucky – only 5 years from seeing GP to getting surgery. Mostly nice doctors. Still can’t afford laser treatment. #TransDocFail@SimonelyMe: Overall because if my 3years 2months & counting wait for a GIC appointment I have been self medicating for 9months #transdocfail@bluefoo: First GIC appointment next week, first went to GP for help 44 months ago #TransDocFail@kara_louise18: #transdocfail having my GIC referral sitting on my GP’s desk and him not doing owt about it for ages, until I went and reminded him.@lilylayer4: #transdocfail I learned my request for treatment was denied in a copy of a letter sent to my GP, without explanation or after support.@major___tom: My GP repeatedly told me she’d referred me when she hadn’t. Took 11 months from asking to be referred to being referred. #TransDocFail@Ithlin: @Lady_Muck666 CHX
told me that they were unable to type out a letter dictated on 13/12/12 earlier than Feb ’13. #TransDocFail

At least delays are not outright refusal to give treatment or right letters

@Aurum_Boss: My GP refsued to re-prescribe anything for 6 years because estrogen was “off-licence”. #TransDocFail@CherylMorgan: GP refused to attest that I’d had surgery so I could get a GRC. I had all my hospital notes, and, you know, a vagina… #TransDocFail@Christabel321: Former GP told me to pull myself together and stop wasting his time #TransDocFail@Ginnheim: I knew a pre-hysto trans man denied HRT after 3 years of being on it.His ‘monthlies’ returned,making him lethargic & miserable #TransDocFail@IntercomTrust: had a teenage client who’s Dr asked him to wait a yearbecause then “you’ll be at uni and the Dr there can deal with it” #TransDocFail@Lady_Muck666: Doc in Jersey refused me treatment point blank I paid £40 for a badly spelled letter telling me2 go away #TransDocFail@LymanSays: I was told to ‘focus on [my] disability, that’s what’sreally important’ – transition apparently being an optional goodie. #transdocfail@elided_: The first GP I told later told me he could no longer treat me because I was trans; he later shredded my notes #TransDocFail@elided_: Subsequent doctors practice withdrew post-op HRT without asking me; had to refuse to leave surgery to get it back #TransDocFail@itsjustabout451: GP: i’m ‘wasting his time’ when he has to prescribe meds as my GIC won’t prescribe but writes to him ‘recommending’ he does… #transdocfail@laurenisolde: #TransDocFail #lies “Legally I can’t prescribe hormones until you have a therapist’s letter”. (Then I found an informed consent clinic)@lolvixen: #TransDocFail I first saw my GP for help 13 years ago. He refused and humiliated me, and suicide was preferable to risking a different GP.@major___tom: GP refused to write me a letter to say I live full-time as male because he said only an endocrinologist could certify that. #TransDocFail@wiriamu: Only doc in my old area that’d treat me without outright contempt or scorn was a pediatrician. I was 23. #TransDocFail

The Transsexual broken arm

So you have treatment! Now every medical issue you have will be related. Broken your arm? It’s probably because you’re Trans. This problem, I have to point out, isn’t confined to the Trans community. When meeting with the General Medical Council last year, they report that people with disabilities or mental health problems get the same treatment.

@PublicMatt: Denied care for a heart condition because “I have all this gender stuff going on so it was probably in my head” #TransDocFail@GreenSkyOverMe: RT @[protected] Insistence on genital exam before chest xray for chest pain #transdocfail #AandEfail@InWhichAlex: Made to wait >2 years for psych appointment (at GIC) before being treated for clear urological problem #TransDocFail@Diran_Sky: I was denied access to a therp. for my depression as Iwas “already seeing” someone at the GIC. for 30mins. every 3-6 months #TransDocFail@Flaneurble: My GP recently outed me to two student docs and then referred to me as a trsnsgender. I only wanted a repeat prescription. #TransDocFail@AutistLiam: My GPs are nice and friendly and completely clueless about trans issues. Suggest every ailment is a side effect of HRT. #TransDocFail@Inkysloth: Local Mental Health services kept refusing my referrals for phobia support as I was seeing a gender identity psychiatrist! #TransDocFail@Jenny_Alto: Denied access to local MH counseling service because “you’re with the GIC”. The GIC don’t do non-specific counseling. #TransDocFail@PublicMatt: Told I probably have BPD by a dr who saw me for 15 mins based on “gender confusion” despite living as male for years #TransDocFail@PublicMatt: Having my physical condition repeatedly called psychosomatic because I’m trans and also have MH problems #transdocfail@SemiStealth: GP refers me to hospital 30 miles away even if it’s just something a simple as a stomach ache #transdocfail@Tara_Hewitt: Hearing consultant flicked through medical file questioning about hormones &my gender dysphoria diagnosis NONE OF HIS BUSINESS #TransDocFail@a_cognito: #TransDocFail I need a (hopefully) routine gynae checkup, but my GP wants to send me back to GIC at Charing Cross@auntysarah: A trans lady I know was refused emergency access to gynaecology for over a year because PCT was arguing over how to pay for it #TransDocFail@embrownbill: Admitted to A&E with dizziness, asked to explain side-effects of my medicine. It’s the same HRT prescribed to 1,000s of women. #TransDocFail@flippac: Shrink blames financial problems due to DWP admin errors on “problems managing money”, apparently transition-related #TransDocFail@flippac: Clinic has no disability training. Disabled, can’t work? No RLE, no HRT. Obviously that depression’s about your transition #TransDocFail@major___tom: Routine appts about non-trans stuff turned into chats about my gender even when I just wanted help for a hurt back or w/e. #TransDocFail@major___tom: GP thought depression was ‘normal’ given my being trans & thus ADs pointless. Even though they alleviate the depression. #TransDocFail@scattermoon: @TheCraftyTracy #TransDocFail H was taken to hospital after losing 2 pints of blood post-op. They didn’t do anything.@scattermoon: @TheCraftyTracy #TransDocFail actually, they did. They brought in a team of nurses to gawk at her because they’d never seen one before.@schokopflaster: All docs have to unbiddenly talk to me about trans* after learning why I’m taking hormones. Even when I see them about a cold. #TransDocFail

Pointless abuse

Sometimes, it goes beyond simple refusal to treat and turns into outright abuse, either deliberate or unthinking, and inappropriate treatment.

@AutistLiam: NHS Psych told me I wanted to transition to male cos Iwas too ugly to live as a woman. Also told me I’d never pass as male #TransDocFail@Diran_Sky: RT my wife was told by sexual health clinic that she’sat high risk for AIDS/STIs because she “has sex with transgenders” #transdocfail@Diran_Sky: RT was turned away at reception of gyno who shouted about “it” and “do they have a vagina” – needed external granuloma removed #transdocfail@JessWardman: was called a “shemale” by the gender specialist psychotherapist pre-GIS referral #TransDocFail@LupieStardust: District nurse taking blood asked me if I was going to have genital surgery. Only there for bloods! #TransDocFail@Oh_Dani_Gal: With that doctor I was required to undergo unnecessarymedical exams to receive HRT, e.g. regular orchidometer checks. #TransDocFail@PublicMatt: Despite explaining my situation was told before a sexual health check that I was “really a woman” #TransDocFail@TheCraftyTracy: #TransDocFail during my visits to A&E during this episode I got groped by a doctor and lectured by a nurse how it was a shame effort was@TheCraftyTracy: #TransDocFail put into trans treatment while there was no cure for cancer. Which is what I needed to hear when bleeding to death.@TinTower: Leeds GIC, as I mentioned last night, were really keen to perform a genital exam. My GP, thankfully, wasn’t. #TransDocFail@a_cognito: #TransDocFail recent foot surgery, I told anaesthetist I’d had vaginoplasty. His reply “Well it takes all sorts….er…I’m OK with that”@a_cognito: #TransDocFail first GIC appt, presenting as female, friendly blood nurse saw I was trans on paperwork “OMG you’re one of them!” #80s #AIDS@auntysarah: A historical #TransDocFail – in the 1990s, the UK’s largest gender clinic would insist you divorced prior to treatment.@eiridescent: Sexually assaulted (breast groping) by endo as a condition of receiving necessary care. #TransDocFail@elided_: Repeatedly been told by GIC that long-term post-op complications are “because you don’t sleep with men”. Feel that’s my fault. #TransDocFail@major___tom: Psychologist, when I asked for a CHX referral from her, asked me how often and how I masturbate #TransDocFail@marliesanna: First thing my GP said after I’d worked up the courageto tell him I was trans: ‘You don’t exactly have a very feminine body’ #TransDocFail@tanyabloomfield: #transdocfail Dr Green (Charing Cross GIC) “you’re going to be an ugly woman”@zoeimogen: I rang NHS Direct to get help for partner. NHS Direct doctor spoke to them and told them to leave me as I was an “abomination” #transdocfail@zoeimogen: Even within the T healthcare community, there’s prejudice. One Dr was worried about “creating she-men” http://www.complicity.co.uk/blog/2012/03/unintentionally-creating-she-men/… #transdocfail

Doctor knows best

You’re really gay, or too young to transition, or it’s your mother. Or something. If an expert said otherwise, I’m still not sure.

@AutistLiam: Me: I’ve lived as male for over a year & want hormones Psych: Young people can live successfully as trans w/o hormones#transdocfail (contd)@Flaneurble: @auntysarah
when I went to GP about GD he said ‘nothing wrong with being gay’ and sent me to a family planning clinic .WTF !! #TransDocFail@Ginnheim: GP refused to prescribe HRT even *after* I’d been recommended them by GIC over concerns that I was “not taking them safely” #TransDocFail@HannaMadeIt: I talked to
my doc about wanting treatment for my dysphoria, I wasn’t “trans enough” #TransDocFail@Inkysloth: One Gender
Identity psychiatrist suggested I was trans because I was rebelling against my lesbian mother. #TransDocFail@JessWardman: had it supposed that I wasn’t really trans because I played D&D and Jess was apparently just a new character for me #TransDocFail@KelestiMMO: #TransDocFail my first doc told me that my disconnect to my body, my reflection, my life, all needed to be medicated, not treated.@Lady_Muck666: I saw 3 psych pro’s about being trans, they ALL told me I was just depressed and to get a job and I’d feel better #TransDocFail@LupieStardust: Told by
psychiatrist at pre-referral evaluation that I was too young to “know for definite”. I was 21. #TransDocFail@MizBrea: First doc I saw in Virginia said “You’re already Intersex, so why bother with the transition nonsense? Isn’t that enough?” #TransDocFail@Oh_Dani_Gal: Had working, appropriate HRT doses severely reduced bya doctor because they, and not
I, wanted my libido to return. #TransDocFail@Starlight_Witch: “you have to be 18 before you make any serious decisions about your gender” #TransDocFail@flippac: Surgeon talks about “the cosmetic op”, mansplains my own sexuality to me. Gee, I had no idea what my clit is/isn’t capable of. #TransDocFail@flippac: Repeatedly implied that I should not identify as butch. Care coordinator cedes to clinic re existence of queer gender roles #TransDocFail@jackiets: When i first went to my GP and explained how i felt hereferred me to a Behavioural Specialist….the dark ages of 2002 #TransDocFail@laurenisolde: #TransDocFail My first endo flat out refused to prescribe hormones because I wasn’t wearing women’s clothing. Apparently I wasn’t serious.@marliesanna: Sexuologist told me I wasn’t trans and shouldn’t go the GIC because I disliked my penis, not severely disliked it. #TransDocFail@marliesanna: Sexuologist officially diagnosed me with transvetic fetishism as GID was too definitive and this was the closest alternative. #TransDocFail@qbnaith: When I said I had no interest in genital surgery my GPtold me I ought to have it cos “sex is very important to some people” #transdocfail@qbnaith: As if sex is the reason for transitioning, and as if Icouldn’t possibly have sex with my genitals the way they currently are.#transdocfail@wiriamu: Was accused by my former endo of supplementing my hormones when she’d prescribed wrong dosage. #TransDocFail@wiriamu: Former shrink wanted me to wait till I was 30 to transition and ‘had experienced male life fully’ #TransDocFail@wiriamu: Said shrink was also convinced that I had Aspergers, and was transitioning to ‘give myself a perpetual role to play’ #TransDocFail

Administrative errors and misgendering

Another common complaint is failure of the NHS to be able to update records to accommodate new names, titles and genders properly. That’s assuming it’s an administrative mistake of course, and not deliberate misgendering or “outing”.

@AutistLiam: @christineburns NHS Psych started “accidentally” mispronouning me and using wrong name when I tried to get her to follow it #TransDocFail@AutistLiam: Despite repeatedly being directed to NHS policy, health centre staff kept saying I’d need a dx of GID before changing records #TransDocFail@AutistLiam: NHS policy is to change name, title and sex on patientrecord on demand. NHS staff refused to believe this when I told them. #TransDocFail@Chastance: MH nurse told suicidal me that they couldn’t use my name because some imaginary guy might want to go by ‘spike’. #TransDocFail@FyremaneFoxx: Been setting up with new GP, when filling out forms onFriday, I was changeing all the Mr. To Ms. & male to female #TransDocFail@InWhichAlex: Psych invented name to call me because I wouldn’t tell him my birth assigned name #TransDocFail@JessWardman: was informed by docs that was not possible to change gender marker at surgery and title was gender-linked. #TransDocFail@Lady_Muck666: Went to my GP presenting as female, asked to change my records, even now they still refer to me as male… #TransDocFail@SimonelyMe: I was continually referred to by my former name even though I had provided copies of the NHS documents on gender variance #transdocfail@a_cognito: #TransDocFail I volunteered I was trans to a chest surgeon who then referred to me as he/him to the nurses@amywok1: @auntysarah just transitioned nervously sat in drs waiting room. Doctor shouted “old name!” , outed by gp. #TransDocFail@cnlester: My GP was, at first, supportive. Then called me a ‘pretty young lady’ during a chest exam – despite my top surgery. #TransDocFail@ctonry: GPs routinely out me to nurses via blood test forms #transdocfail@ctonry: GP thought I was cis at the beginning of an appointment, but managed to misgender me by the end #transdocfail@embrownbill: 3 years after explaining how dangerous (and unlawful) it is, my GP still prints HRT prescriptions for “Mr Emma Brownbill”~ #TransDocFail@embrownbill: GP put previous name and trans status on a referral for unrelated treatment. Only found out when I needed the letter for Uni. #TransDocFail@major___tom: Took receptionist 4 months & 3 copies of my deed poll to update name & title. Having Miss Tom Robinson outed me in meantime. #TransDocFail@major___tom: Receptionist ‘forgot to write down’ my first psych appt for a CHX referral & I had to rebook. Another 2 months’ delay. #TransDocFail@thebeardlessone: Also, he filled in a form with a preferred name box without asking me, put in my birth name. I have no proof this was fixed.#TransDocFail@thekeywordgeek: Repeated misgendering of elderly trans woman friend dying of cancer by male nursing staff who shoulda known better. #TransDocFail@zoeimogen: Doctor treating one of my kids refused to use “Ms. O’Connell” in notes. Insisted on male titles/pronouns. In front of the kid. #transdocfail

Jumping through hoops

Can’t make an appointment? Dared go private? It’s back to square one.

@Aurum_Boss: In 2004 Charing Cross GIC kicked me off their treatment programme because I’d missed one appointment. #TransDocFail@Diran_Sky: depression, anxiety and heavy snow made me miss 1 app at the GIC, then i was informed I had been removed from their books #TransDocFail@S0phieH: #TransDocFail cancelled appointment for surgery to look after dying father. can’t get another appt. without ‘re-proving’ I’m still trans@Tara_Hewitt: Diagnosed privately wanted nhs surgury referrals afteryrs on hrt told id have to go back at beginning of treatment pathway #TransDocFail@auntysarah: A few weeks from surgery, Cambs PCT said they wouldn’tfund me unless I started as a new GIC patient, with a 2 year wait. #TransDocFail@auntysarah: This was, ostensibly, so the referral would meet with their surgeon’s acceptance criteria. It was the same surgeon. #TransDocFail

Non-binary genders don’t exist

Even vague transgressions will be punished: I demand that you conform to my ideals about gender! Remember Vazquez from Aliens? Some doctors don’t apparently. (Really, this topic could do with a blog post on it’s own.

@Diran_Sky: Any talk of being non-binary was quashed swiftly. very much felt binary was the only way they would accept #TransDocFail@miah_: My first therapist told me to do things a “real girl” would do. Her example was to go see “Sex in the City(movie)”. #TransDocFail@Oh_Dani_Gal: Was refused transition treatment for being lesbian, riding motorcycles, and not wearing skirts and heels to appointments. #TransDocFail@Sirius7dk: Interesting to read the #TransDocFail hashtag whilst i am on my way to a doctor thathas already refused me HRT for being non-binary

It seems David Batty, Guardian “journalist”, has come out of his self-imposed retirement on writing about Trans issues to produce a rather obviously spun story on Doctor Richard Curtis, a private doctor who practices in London.

So with that background, let’s have a look at today’s article. Here’s what he’s detailed the complaints as, and I’ll deal with them point by point with reference to the WPATH Standards of Care(PDF Link).

Commencing hormone treatment in complex cases without referring the patient for a second opinion or before they had undergone counselling

There is no requirement for a second opinion or counseling prior to prescribing hormones, despite the attempt to insinuate that there is. The requirements are persistent gender dysphoria, capacity to give informed consent, being an adult (Kids have different rules) and other medical or mental concerns being “reasonably well-controlled.” (Page 104)

Administering hormone treatment at patients’ first appointments

See the above list of requirements for HRT. There is no reason not to prescribe hormones if the persistent gender dysphoria is well documented. (For example, the patient may already have transitioned, may have seen other doctors before going private or may have been on NHS waiting lists for an extended period of time)

Referring patients for surgery before they had lived in their desired gender role for a year, as international guidelines recommend

This is routine, as for transwomen genital electrolysis (Hair removal) cannot be rushed due to the growth cycle of hair, meaning some months of advanced planning is needed. The international guidelines (I.e. the WPATH SoC) state you cannot have surgery prior to the 12 month point (Pages 105-106) but make no mention of referrals.

I am assuming this is referring to genital surgery. For top surgery (Either breast enlargement or removal, depending on which way someone is transitioning) the requirements are less strict. (Page 105)

With one patient allegedly undergoing surgery within 12 months of their first appointment

There is no minimum treatment period, only a minimum period of documented real life experience which does not need to be under the care of a doctor. If there was a violation, why isn’t the surgeon concerned also be under investigation by the GMC, or the doctor who issued the second required signature for surgery?

He is also accused of administering hormones to patients aged under 18 without an adequate assessment

There is also a later reference to referring to prescribing at 16 and probably the point of greatest concern, but it’s not clear where the cutoff between adolescent and adult care begins. In terms of the WPATH SoC, it simply states the “age of majority in the country concerned” as being the cutoff between adolescent and adult provisions. The is no clear age of majority in the UK, and even the General Medical Council’s own guidance isn’t clear if it’s at 16 or 18 (Or younger) for medical purposes.

Finally…

Wrongly stating that a patient seeking gender reassignment had changed their name.

If we’re having to drag what sounds like an administrative error (And this happens more often in the NHS than private practice) then we’re really grasping at straws.

He goes on:

One of the most serious cases concerns a female patient who regrets switching to a male role. She underwent hormone treatment and had her breasts removed. The woman is one of the complainants in the current GMC investigation.

There’s nothing in here to suggest malpractice. Just a statement that someone regretted transition. Of course, there are those who will be horrified that someone had their “breasts removed” and no doubt this paragraph is designed to stoke the emotions of such readers.

Of course, Batty knows what is and isn’t acceptable and is no doubt aware of these holes in his character assassination of Dr. Curtis. He’s been after us for long enough and knows about the WPATH Standards of Care. He even quotes them later on in the article, despite the fact they indicate many of the “complaints” he lists are not themselves malpractice but rather a list of potentially routine tems that those with no knowledge of the topic might see and an example of why Trans healthcare, either NHS or Private, is fundamentally Evil.

Is all this noise significant? At this stage we don’t know. Even Batty may not know, because I’m sure if he had hard examples of WPATH SoC guidelines, he would have published them with glee. A sentence later on in the article revels that the council still have to even decide “if there is a case to answer” so really we just don’t know yet.

Whatever happens, there needs to be a mechanism for resolving what is acceptable care that does not jeopardize careers, reinforce outdated and harmful practice, facilitate witch hunts and damage access to healthcare for the whole Trans community.